Healthcare Provider Details

I. General information

NPI: 1356861272
Provider Name (Legal Business Name): MELISSA G WARD RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 TURNER MCCALL BLVD
ROME GA
30165
US

IV. Provider business mailing address

304 TURNER MCCALL BLVD SW
ROME GA
30165-5621
US

V. Phone/Fax

Practice location:
  • Phone: 706-509-5185
  • Fax: 706-292-7577
Mailing address:
  • Phone: 706-509-5185
  • Fax: 706-292-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN069316
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: